It will be our 30 year re-union soon and I will be travelling to Cardiff to reminisce with my classmates of 1985. That Class of 1985 is now full of fifty-something-year-old doctors. Thirty years is a long time in medicine.
I can remember that as a newly trained GP, my non-medical friends would tell me their tales of experience with the health service and with their GPs. “I have phoned my GP for an appointment and I have been given an appointment in two weeks’ time. Two weeks’ time! I am ill now, and I could be dead in two weeks” one friend told me. I tried in vain to explain about the system of appointments. My friend didn’t understand that most flu-like illnesses are self-limiting. She felt unwell and wanted to feel better as soon as possible. Surely her GP should be able to prescribe something that would make her feel better?
Thirty years later I have a similar conversation with many patients. They do not want to take time off work, because of the strict monitoring of ‘sick time’ off in most work places. They have been unwell for three, five or seven days already. I examine them and tell them that it may take up to 3 weeks to get better from their flu like viral illness. “There’s a new virus going around,” I explain.
Some are reassured, others are not convinced and yet others think they have wasted their time in coming to see me. “That doctor is no good, a complete waste of time. All doctors do is just tell you to take paracetamol.” The message about self limiting viral illness has not got across to the general public. Which forms of education, communication and skills could improve this scenario?
I have increasingly noted that my consultation starts with the patient telling me “Doctor I have been trying to get an appointment for 4 weeks and there are no free appointments” or “I phone at 8am and I can’t get through. When I get through there are no appointments left, so they just tell me to phone the next day”. I often work as a locum, and this conversation with patients takes place in the inner-city practices, in the middle class areas, in those practices with stable long term staff, those practices that frequently use locums and in practices with a high turnover of staff. “I am sorry about that. What can I do for you today?” I ask sympathetically. “Well I have a few things I want to talk about.” My heart sinks a little… I have about 7.5 minutes of the consultation time left. “Can you tell me the problems and we can can deal with the most important one today? I am sorry.” The consultation continues… I was already running a little late and by the end of this consultation I am running more than 15 minutes late. I call the next patient in. “I am sorry to keep you waiting,” The patient is very understanding. “What can I do for you today?” “Well doctor, I don’t know where to begin.” I realise this is not going to be a seven or ten minute consultation.
The next patient is called in and tells me: “Doctor I have been to outpatients and had a scan, but have not got an appointment for the results”. I tell the patient “I am sorry about that. I will ask the secretary to chase up the clinic appointment.”
It seems that the next patient has not arrived. So I feel a sense of calm. I call the following patient in and conduct a consultation and deal with two problems.
The patient who I thought had not arrived has now arrived. An elderly patient has come with her daughter. The patient has had a recent bereavement of her spouse and there are concerns about living alone, memory impairment, insomnia and low mood. I often wonder if we have researched how long it takes to do an MMSE. It takes me at least six or eight minutes to do. I check that the address details are correct on the computer system. I note the patient’s daughter’s name and contact detail in the computer system. I think that consultation took about 20 minutes. I am really running late and a little agitated. It’s at this point that I know I am going to continue to run late, and that I will be starting all subsequent consultations by saying “I am sorry to have kept you waiting”.
I realise that maybe I have had a little crisis today, or is it the beginning of professional burnout?